Where Homeless Meets Crazy (a response to the NYT op-ed, 11/7/2015)

Place and its cultural mores surely must play a role in how we work with those who are struggling with mental health issues, especially those unfortunate enough to be living on the streets of our cities and towns across our country and around the globe.

But as importantly, we need to be even more relativistic and focus on the individual, adopting a consumer choice model of service, rather than a paternalistic approach that dictates a specific, set treatment regimen which too often labels (or worse punishes) those for refusing treatment as being “non-compliant.” Unfortunately, the latter is the usual method adopted by service providers working with those on the street or operating shelters. And while the former approach may be more nuanced and won’t satisfy our impatient impulses to demand immediate results, it will ultimately prove to be one in which we’re seeing more lasting outcomes.

Moreover, we also have to be careful not to be overly focused on the individual, ignoring the structural issues that play an important role in perpetuating the problem, such as the lack of quality community-based health and mental health programs that fail to provide a safety net of support for those in need.

And, finally, for real change to occur, we must be prepared to drop old notions that people struggling with mental health problems, even severe ones, are not “housing ready.” Instead, we must appreciate how a real home becomes the locus of all things positive. The research literature – and our own on-the-ground experience - has certainly confirmed that course for years now.